By: Wayne Henry Zemelka, DC
The Thompson Technique
The existence of the Negative Derifield is determined by the Leg Length Insufficiency (LLI) associated with the finding of the short leg in extension that stays short upon flexion. Confirmation is determined by the finding of two or more of the four trigger points located at the PSIS, Medial Knee, Posterior Ischium, and the Pubic Tubercle, all on the short leg or involved side.
If we do not have the four points of tenderness, it indicates that there is a rotated 5th lumbar that will need to be adjusted. Additionally we have determined that there is no cervical involvement, and now we can proceed to the adjustment of the patient, with the “Classical” Thompson adjustment procedure.
The pelvis is placed on the pelvic portion of the table, with the sacrum being stabilized on the flat surface of the pelvic piece. You can also use a flat board (such as an SOT board) or, as on some tables, insert the blocker that is made to fit into the gonadal cutout on the table. With the patient supine on the segmental drop table we will contact the posterior ischium with contact point number eight of your hand, and stabilization will be on the anterior crest of the same side (Fig. 1). This adjustment procedure affects primarily the sacral involvement, where the apex of the sacrum is rotated away from the involved short leg.
For a first-time patient, explain and demonstrate on the spine what you will be doing, so as to alleviate any apprehension prior to the adjustment. Make sure to also set the pelvic and lumbar drop pieces to the weight of the patient, and use a minimum amount of tension.
You want the drop sections to be disengaged with a light amount of thrust on the part of the doctor. Once you have explained and demonstrated to the patient what you will be doing, slide the contact hand along the thigh and contact the posterior ischium on the short leg side (Fig. 2). You will have your elbow lowered on your contact hand, and the thrust is up towards the shoulder of the same side, keeping the line of drive more on the horizontal plane than toward the floor. Three thrusts will be sufficient to accomplish the adjustment. You can also note that the leg on the involved side will be slightly shorter after the “Part One” adjustment.
It is important that I also bring to your attention that certain drop tables have the facility to vary the angle of the pelvic drop. On those tables be sure to use the down and cephalic direction on “Part One” of the adjustment. On “Part Two” change the drop to straight down, remembering to check the drop tension, since you will change the distribution of the patient’s weight.
Ask the patient to locate the pubic tubercle, and then place your thumbs over the area. We want to mark the pubic area with the thumb as shown in Figure 3, to act as a reference point, so that we will be above the pubic tubercle along the line of the ilio-inguinal ligament (pouparts ligament). Often in a Negative Derifield the pubic bones are very tender, and staying an inch or so above them will be more comfortable for the patient.
The segmental contact point is really at the ilioinguinal ligament and the anterior crest of the pelvis with the thenar over the ligament. Stabilization is on the opposite leg that has been bent in order to stabilize the opposite ilium (Fig. 4). It is important that you have your shoulder directly over the contact area of the pelvis and that the direction of thrust is primarily a torque action toward the midline. Line of drive must be along a path that will correct the subluxation without causing distortion to the area that is being corrected. Therefore, knowledge of the articulations of the body is very important, especially when it comes to the complexity of the sacral-iliac joints, in that they are angled much like a wedge bilaterally.
Keep in mind that this is only one of the Basic Five Categories of analysis and adjustment in the Thompson work. There are other parts of this technique that correlate nicely with checks and balances in the analysis system, adding a dimension of information gathering that will aid the doctor of Chiropractic.
On some new patients (and those who have not been adjusted for a period of time), you may find that the patient’s leg check has changed to a Positive Derifield after the adjustment. This is referred to as a “Reversal Syndrome.” Have the patient walk down the hall and check the leg length again. If there is still a short leg adjust the finding, then proceed with the remainder of your examination and adjusting of the pelvis and spine. Occasionally a rotated 5th lumbar will also still be present, and you should examine the patient and adjust the lumbar to clear the LLI.
Levels of Involvement
A key item in our analysis is the tenderness found at the medial portion of the knee on the involved side. This is caused by the contraction of primarily the semitendinosis and semimembranoses muscles, which create a tilting of the pelvis and add to the instability of the spine and the lower limb. In some cases you may find that there is an underlying cause created by problems of the knee, feet, and ankles. An anterior rotated tibia will contribute to this “Levels of Involvement” problem further complicated by pronation of one or both feet. Adjustment of the knee, ankle, and feet may be in order to get this patient back on the road to good health.
In addition to the adjusting procedures that your patient needs, you must also take into consideration the necessity of custom-made, flexible orthotics to stabilize the pelvis and lower extremities. Excessive pronation of the feet and lack of proper arch support will contribute to the instability of the body and most definitely affect the proprioceptive balancing system of the entire body.
About the Author
Dr. Wayne Henry Zemelka is a 1975 graduate of Palmer College of Chiropractic. He was Faculty President for six years in the 1980’s, during which time he built and operated the Media Production Department for Television and Video and was instrumental in production of classroom instruction videos and operation of the Printing Department. “Dr. Z” also taught in the Technique Department, Business Management and Continuing Education. In 1997 he was elected once more as Faculty President. He retired from Palmer in 1998.